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Heinzelbecker J, Kaßmann K, Ernst S, Meyer-Mabileau P, Germanyuk A, Zangana M, Wagenpfeil G, Ohlmann CH, Cohausz M, Stöckle M, Lehmann J. Long-term quality of life of testicular cancer survivors differs according to applied adjuvant treatment and tumour type. J Cancer Surviv 2024:10.1007/s11764-024-01580-9. [PMID: 38658465 DOI: 10.1007/s11764-024-01580-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/29/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To evaluate the quality of life (QoL) in long-term testicular cancer (TC) survivors. METHODS QoL was assessed in TC survivors treated between March 1976 and December 2004 (n = 625) using the EORTC-QLQ-C30 questionnaire, including a TC module. The assessment was performed at two time points (2006: response rate: n = 201/625 (32.2%), median follow-up (FU): 12.9 years (range 1.1-30.9); 2017: response rate: n = 95/201 (47.3%), median FU: 26.2 years (range: 13.0-41.2)). TC survivors were grouped according to treatment strategy, tumour entity, clinical stage and prognosis group. Linear and multiple linear regression analyses were performed, with age and time of follow-up as possible confounders. RESULTS Radiation therapy (RT) compared to retroperitoneal lymph node dissection (RPLND) was associated with a higher impairment of physical function (2017: β = - 9.038; t(84) = - 2.03; p = 0.045), role function (2017: β = - 12.764; t(84) = - 2.00; p = 0.048), emotional function (2006: β = - 9.501; t(183) = - 2.09; p = 0.038) and nausea (2006: β = 6.679; t(185) = 2.70; p = 0.008). However, RT was associated with a lower impairment of sexual enjoyment (2017: symptoms: β = 26.831; t(64) = 2.66; p = 0.010; functional: β = 22.983; t(65) = 2.36; p = 0.021). Chemotherapy (CT), compared to RPLND was associated with a higher impairment of role (2017: β = - 16.944; t(84) = - 2.62; p = 0.011) and social function (2017: β = - 19.160; t(79) = - 2.56; p = 0.012), more insomnia (2017: β = 19.595; t(84) = 2.25; p = 0.027) and greater concerns about infertility (2017: β = 19.830; t(80) = 2.30; p = 0.024). In terms of tumour type, nonseminomatous germ cell tumour (NSGCT) compared to seminoma survivors had significantly lower impairment of nausea (2006: β = - 4.659; t(187) = - 2.17; p = 0.031), appetite loss (2006: β = - 7.554; t(188) = - 2.77; p = 0.006) and future perspective (2006: β = - 12.146; t(175) = - 2.08; p = 0.039). On the other hand, surviving NSGCT was associated with higher impairment in terms of sexual problems (2006: β = 16.759; t(145) = 3.51; p < 0.001; 2017: β = 21.207; t(63) = 2.73; p = 0.008) and sexual enjoyment (2017: β = - 24.224; t(66) = - 2.76; p = 0.008). CONCLUSIONS The applied adjuvant treatment and the tumour entity had a significant impact on the long-term QoL of TC survivors, even more than 25 years after the completion of therapy. Both RT and CT had a negative impact compared to survivors treated with RPLND, except for sexual concerns. NSGCT survivors had a lower impairment of QoL compared to seminoma survivors, except in terms of sexual concerns. IMPLICATIONS FOR CANCER SURVIVORS Implications for cancer survivors are to raise awareness of aspects of long-term and late effects on QoL in TC survivors; offer supportive care, such as psycho-oncological support or lifestyle modification, if a deterioration in QoL is noticed; and avoid toxic treatment without compromising a cure whenever possible.
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Affiliation(s)
- Julia Heinzelbecker
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany.
| | - Karla Kaßmann
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
- Department of Neurology, Heilig Geist-Krankenhaus, Graseggerstr. 105, 50737, Cologne-Longerich, Germany
| | - Simone Ernst
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
- Centre of Palliative Care and Pediatric Pain, Saarland University Medical Centre and Saarland University, Kirrbergerstr. 100, 66421, Homburg/Saar, Germany
| | - Pia Meyer-Mabileau
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
| | - Aleksandra Germanyuk
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
| | - Miran Zangana
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Gudrun Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University Campus Homburg/Saar, 66421, Homburg/Saar, Germany
| | - Carsten H Ohlmann
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
- Department of Urology, Johanniter Krankenhaus, Johanniterstr. 3-5, 53113, Bonn, Germany
| | - Maximilian Cohausz
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
- Urologische Gemeinschaftspraxis Münster, Fürstenbergstr. 5, 48147, Münster, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
| | - Jan Lehmann
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
- Urologische Gemeinschaftspraxis Pruener Gang, Pruener Grang 15, 24103, Kiel, Germany
- Städtisches Krankenhaus Kiel, Chemnitzstr. 33, 24116, Kiel, Germany
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Dieckmann KP, Tharun L, Angerer M, Harms A, Wülfing C. Myoid gonadal stromal tumor of the testis-the novel subtype of testicular gonadal stromal tumors: a case report and review of the literature. J Med Case Rep 2024; 18:71. [PMID: 38383445 PMCID: PMC10882757 DOI: 10.1186/s13256-024-04393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Sex cord gonadal stromal tumors compose less than 10% of all testicular neoplasms and consist of a variety of histological subtypes. In 2016, the World Health Organization introduced a novel subtype, the myoid gonadal stromal tumor, that consists of spindle-shaped cells with immunohistologic features of muscle cells. Only few cases have been reported to date. Due to its rarity and owing to its only recent introduction, the current knowledge about myoid gonadal stromal tumor is limited, and particularly, appropriate clinical management is still ill-defined. CASE PRESENTATION A 47-year-old man of Caucasian descent presented with nonspecific scrotal discomfort. A roundish and well demarcated hypoechoic mass of 8.5 mm in diameter was detected in the cranial region of the left testis. Serum tumor marker levels were within normal ranges. Testis-sparing surgery revealed a 9-mm whitish, hard mass with sharp surgical margin. Histologically, the neoplasm consisted of microfibrillar tissue with spindle-shaped cells harboring elongated nuclei. Immunohistochemical work-up disclosed expression of desmin, small muscle actin, and S100 protein giving evidence for the myogenic nature of the neoplastic cells. There was no indication of malignancy, neither histologically nor clinically. Follow-up of 1 year was uneventful. CONCLUSION A literature survey revealed 22 previous cases of myoid gonadal stromal tumor. The median age was 37 years, the median size of the neoplasm was 20 mm, and there was no side-preponderance. Myoid gonadal stromal tumor is not much different from other subtypes of gonadal stromal tumors nor from testicular gem cell tumors regarding age and laterality; however, tumor size is smaller in myoid gonadal stromal tumors than in germ cell tumors. Although rarely performed so far, testis-sparing surgery probably constitutes an appropriate treatment of this neoplasm. Myoid gonadal stromal tumor represents an emerging novel entity of benign testicular new growths that caregivers of patients with testicular tumors should be aware of.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Testicular Cancer Unit, Department of Urology, Asklepios Klinik Altona, Paul Ehrlich Strasse 1, 22763, Hamburg, Germany.
| | - Lars Tharun
- Medizinisches Versorgungszentrum Hanse Histologikum, Fangdieckstrasse 75a, 22547, Hamburg, Germany
| | - Markus Angerer
- Testicular Cancer Unit, Department of Urology, Asklepios Klinik Altona, Paul Ehrlich Strasse 1, 22763, Hamburg, Germany
| | - Alexander Harms
- Medizinisches Versorgungszentrum Hanse Histologikum, Fangdieckstrasse 75a, 22547, Hamburg, Germany
| | - Christian Wülfing
- Testicular Cancer Unit, Department of Urology, Asklepios Klinik Altona, Paul Ehrlich Strasse 1, 22763, Hamburg, Germany
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Belge G, Dumlupinar C, Nestler T, Klemke M, Törzsök P, Trenti E, Pichler R, Loidl W, Che Y, Hiester A, Matthies C, Pichler M, Paffenholz P, Kluth L, Wenzel M, Sommer J, Heinzelbecker J, Schriefer P, Winter A, Zengerling F, Kramer MW, Lengert M, Frey J, Heidenreich A, Wülfing C, Radtke A, Dieckmann KP. Detection of Recurrence through microRNA-371a-3p Serum Levels in a Follow-up of Stage I Testicular Germ Cell Tumors in the DRKS-00019223 Study. Clin Cancer Res 2024; 30:404-412. [PMID: 37967143 PMCID: PMC10792362 DOI: 10.1158/1078-0432.ccr-23-0730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/16/2023] [Accepted: 11/13/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE Surveillance of clinical stage I (CSI) testicular germ cell tumors (GCT) is hampered by low sensitivity and specificity of current biomarkers for detecting relapses. This study evaluated if serum levels of microRNA371a-3p (M371 test) can: (i) Accurately detect relapses, (ii) detect relapses earlier than conventional technology, and (iii) if elevated postoperative M371 levels may predict relapse. EXPERIMENTAL DESIGN In a multicentric setting, 258 patients with testicular CSI GCT were prospectively followed by surveillance for a median time of 18 months with serial measurements of serum M371 levels, in addition to standard diagnostic techniques. Diagnostic characteristics of M371 for detecting relapses were calculated using ROC curve analysis. RESULTS Thirty-nine patients recurred (15.1%), all with elevated M371 levels; eight without relapse had elevations, too. The test revealed the following characteristics: area under the ROC curve of 0.993, sensitivity 100%, specificity 96.3%, positive predictive value 83%, negative predictive value 100%. Earlier relapse detection with the test was found in 28%, with non-significant median time gain to diagnosis. Postoperative M371 levels did not predict future relapse. CONCLUSIONS The sensitivity and specificity of the M371 test for detecting relapses in CSI GCTs are much superior to those of conventional diagnostics. However, post-orchiectomy M371 levels are not predictive of relapse, and there is no significant earlier relapse detection with the test. In all, there is clear evidence for the utility of the M371 test for relapse detection suggesting it may soon be ready for implementation into routine follow-up schedules for patients with testicular GCT.
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Affiliation(s)
- Gazanfer Belge
- Department of Tumor Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Cansu Dumlupinar
- Department of Tumor Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Tim Nestler
- Department of Urology, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany
| | - Markus Klemke
- Department of Tumor Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Peter Törzsök
- Department of Urology and Andrology, Paracelsus Medical University, Salzburg University Hospital, Salzburg, Austria
| | | | - Renate Pichler
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | - Wolfgang Loidl
- Ordensklinikum Barmherzige Schwestern, Department Urology, Linz, Austria
| | - Yue Che
- Department of Urology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Andreas Hiester
- Department of Urology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Cord Matthies
- Department of Urology, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - Martin Pichler
- Research Unit of Non-Coding RNA, Division of Oncology, Medical University of Graz, Graz, Austria
| | - Pia Paffenholz
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Luis Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Jörg Sommer
- Department of Urology, St. Franziskus Krankenhaus Lohne, Lohne, Germany
| | - Julia Heinzelbecker
- Saarland University Medical Centre and Saarland University, Department of Urology, Homburg, Germany
| | | | - Alexander Winter
- Department of Urology, University Hospital Oldenburg, Oldenburg, Germany
| | | | - Mario Wolfgang Kramer
- Department of Urology, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marie Lengert
- Department of Tumor Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Jana Frey
- miRdetect GmbH, Bremerhaven, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
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Dieckmann KP, Klemke M, Grobelny F, Radtke A, Dralle-Filiz I, Wülfing C, Belge G. Serum Levels of MicroRNA-371a-3p (M371) Can Predict Absence or Presence of Vital Disease in Residual Masses After Chemotherapy of Metastatic Seminoma. Front Oncol 2022; 12:889624. [PMID: 35600346 PMCID: PMC9121896 DOI: 10.3389/fonc.2022.889624] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundRadiological evaluation of postchemotherapy residual masses of metastatic seminoma is characterized by poor diagnostic accuracy. Serum levels of microRNA-371a-3p (M371) involve high specificity and sensitivity for the primary diagnosis of seminoma. We evaluated if M371 levels can indicate the presence of vital disease in postchemotherapy residual masses in patients with metastatic seminoma.MethodsTwenty-three seminoma patients (median age 52 years) with residual masses had posttreatment measurements of serum M371 levels (group A), fourteen of whom had measurements also beforehand. The posttreatment results were compared with the clinical outcome during follow-up. Eleven patients with complete remission after treatment of metastatic seminoma (group B) and 33 men with non-malignant testicular diseases (group C) served as controls. M371 serum levels were measured by quantitative real-time PCR using miR-30b-5p as endogenous control. An evaluation was performed with descriptive statistical methods.ResultsTwenty-two patients of Group A had uneventful follow-up so far, twenty-one of whom had M371 level <5, and one other had a mildly elevated level below relative quantity (RQ) = 10. One patient with a level of RQ = 26.2 rapidly progressed. The median posttreatment M371 level of the non-progressing patients of group A is not significantly different from the median level of the control group with complete remission (B). Before treatment, the median M371 levels in groups A and B were 507.6 and 143.9, respectively. In both groups, significant drops in M371 levels resulted from treatment.ConclusionNormal M371 serum levels at the time of completion of treatment of metastatic seminoma indicate the absence of vital seminoma in residual masses, while elevated levels >RQ = 10 predict the presence of disease. The optimal timing of M371 measurement after chemotherapy and the appropriate cutoff level still need to be determined. Based on the present results, measuring serum M371 levels involves the potential of a novel tool for assessing postchemotherapy residual masses of metastatic seminoma.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
- Department of Urology, Albertinen Krankenhaus, Hamburg, Germany
| | - Markus Klemke
- Faculty of Biology & Chemistry, University of Bremen, Bremen, Germany
| | | | | | | | | | - Gazanfer Belge
- Faculty of Biology & Chemistry, University of Bremen, Bremen, Germany
- *Correspondence: Gazanfer Belge,
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Dieckmann KP, Ruf CG, Gübitz R, Wülfing C, Zengerling F. [Follow-up of testicular germ cell tumors-historical aspects and current recommendations]. Urologe A 2022; 61:484-494. [PMID: 35384479 DOI: 10.1007/s00120-022-01815-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/28/2022]
Abstract
Systematic follow-up examinations of patients cured of testicular cancer first gained attention by caregivers in the 1980s only after the management of the disease had significantly been improved by the introduction of cisplatin-based chemotherapy and almost synchronously, by the implementation of computerized tomography (CT) and serum tumor markers. Follow-up involves three aims: early diagnosis of recurrence, detection of treatment-related toxicity, and detection of secondary diseases. As the clinical presentation of testicular cancer is very heterogeneous, there is no uniform follow-up for the disease. Instead, risk-adapted follow-up schedules are required. Since the release of the German AWMF S3 guideline for the management of testicular cancer in 2019, high level evidence has accumulated for the noninferiority of magnetic resonance imaging (MRI) to CT with regard to abdominal imaging. Therefore, it is appropriate to modify the recommendations for follow-up given in the 2019 issue of the S3 guidelines. The modifications recommended herein relate to three issues: (1) Only three risk groups (instead of formerly four) are identified, i.e., seminoma (all stages); nonseminoma clinical stage 1b (i.e., pT2, with lymphovascular invasion) on surveillance; nonseminoma all other stages. All patients cured from poor risk disease or from relapses require individual follow-up schedules not included in the recommendations tabulated herein. (2) CT and abdominal sonography are replaced by MRI. (3) Chest X‑ray imaging during follow-up of seminoma patients is no longer recommended.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Urologische Abteilung, Hodentumorzentrum, Asklepios Klinik Altona, Paul Ehrlich Straße 1, 22763, Hamburg, Deutschland.
| | | | - Raphael Gübitz
- Institut für Radiologie und Neuroradiologie, Asklepios Klinik Altona, Hamburg, Deutschland
| | - Christian Wülfing
- Urologische Abteilung, Hodentumorzentrum, Asklepios Klinik Altona, Paul Ehrlich Straße 1, 22763, Hamburg, Deutschland
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Madanchi R, Engel NW, Alsdorf W, Oing C, Frenzel C, Paulsen FO, Bokemeyer C, Seidel C. Approaches of stem cell mobilization in a large cohort of metastatic germ cell cancer patients. Bone Marrow Transplant 2022. [PMID: 35190673 DOI: 10.1038/s41409-022-01614-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 11/08/2022]
Abstract
High-dose chemotherapy (HD-Cx) in refractory germ cell cancer (GCC) is effective but limited data are available concerning the optimal approach for stem cell mobilization (SCM) in these patients. In this analysis 102 patients undergoing SCM during first (n = 25) or subsequent treatment lines (n = 77) were analyzed. Subcutaneous injections of granulocyte colony-stimulating factor (G-CSF) were given once daily (group 1) in 52 patients (51%), twice daily (group 2) in 39 patients (38%) or one injection Pegylated-G-CSF (PegG-CSF) (group 3) in eleven patients (11%) after one cycle of mobilization chemotherapy. Plerixafor was administered 13 times in group 1, seven times in group 2 and once in group 3. Overall, 77 (75%) patients achieved successful SCM defined as ≥8*106 CD34+ cells/kg body weight for three consecutive HD-Cx plus one backup dose. In group 1, 40 of 52 patients (77%) achieved successful SCM with a median of 11 G-CSF injections, in group 2, 27 of 39 patients (69%) with a median of 14 G-CSF injections and in group 3, 10 of 11 patients (91%) with one injection of PegG-CSF. SCM was more successful if conducted during first-line chemotherapy (p = 0.016) and associated with a beneficial outcome concerning overall survival (p = 0.02) if performed satisfactorily.
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Zengerling F, Beyersdorff D, Busch J, Heinzelbecker J, Pfister D, Ruf C, Winter C, Albers P, Kliesch S, Schmidt S. Prognostic factors in patients with clinical stage I nonseminoma-beyond lymphovascular invasion: a systematic review. World J Urol 2022; 40:2879-87. [PMID: 35906286 DOI: 10.1007/s00345-022-04063-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 05/18/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To systematically evaluate evidence on prognostic factors for tumor recurrence in clinical stage I nonseminoma patients other than lymphovascular invasion (LVI). METHODS We performed a systematic literature search in the biomedical databases Medline (via Ovid) and Cochrane Central Register of Controlled Trials (search period January 2010 to February 2021) for full text publications in English and German language, reporting on retro- or prospectively assessed prognostic factors for tumor recurrence in patients with stage I nonseminomatous germ cell tumors. RESULTS Our literature search yielded eleven studies reporting on 20 potential prognostic factors. Results are based on cohort studies of mostly moderate to low quality. Five out of eight studies found a significant association of embryonal carcinoma (EC) in the primary tumor with relapse. Among the different risk definitions of embryonal carcinoma (presence, predominance, pure), presence of EC alone seems to be sufficient for prognostification. Interesting results were found for rete testis invasion, predominant yolk sac tumor, T-stage and history of cryptorchidism, but the sparse data situation does not justify their clinical use. CONCLUSIONS No additional factors that meet the prognostic value of LVI, especially when determined by immunohistochemistry, could be identified through our systematic search. The presence of EC might serve as a second, subordinate prognostic factor for clinical use as the data situation is less abundant than the one of LVI. Further efforts are necessary to optimize the use of these two prognostic factors and to evaluate and validate further potential factors with promising preliminary data.
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Busch J, Schmidt S, Albers P, Heinzelbecker J, Kliesch S, Lackner J, Pfister D, Ruf C, Winter C, Zengerling F, Beyersdorff D. Can magnetic resonance imaging replace conventional computerized tomography for follow-up of patients with testicular cancer? A systematic review. World J Urol 2022; 40:2843-2852. [PMID: 35037965 PMCID: PMC9712293 DOI: 10.1007/s00345-022-03931-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/05/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Follow-up protocols for patients with testicular cancer (TC) have significantly reduced the number of cross-sectional imaging studies to reduce radiation exposure. At present, it is unclear whether magnetic resonance imaging (MRI) could replace conventional computerized tomography (CT) imaging. The objective of this study is to summarize the scientific evidence on this topic and to review guideline recommendations with regard to the use of MRI. METHODS A systematic literature review was performed searching Medline and Cochrane databases for prospective studies on patients with TC in the follow-up care (last search in February 2021). Additionally, guideline recommendations for TC were screened. Data extraction and quality assessment of included studies were performed and used for a descriptive presentation of results. RESULTS A total of four studies including two ongoing trials were identified. Overall, the scientific evidence of prospective comparative studies is based on 102 patients. Data suggest that abdominal imaging with MRI can replace conventional CT for detection of lymph node metastasis of the retroperitoneum to spare radiation exposure and contrast media application. However, experienced radiologists are needed. Clinical guidelines are aware of the risk of diagnosis-induced secondary malignancy due to CT imaging and some have adapted their recommendations accordingly. Results of the two ongoing trials on 738 patients are expected soon to provide more reliable results on this topic. CONCLUSIONS There is growing evidence that abdominopelvic MRI imaging can replace CT imaging during follow-up of patients with TC in order to reduce radiation exposure and diagnosis-induced secondary malignancy.
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Affiliation(s)
- Jonas Busch
- grid.6363.00000 0001 2218 4662Department of Urology, Charité Universitaetsmedizin Berlin, Berlin, Germany ,grid.433867.d0000 0004 0476 8412Department of Urology, Vivantes Klinikum Am Urban, Dieffenbachstr. 1, 10967 Berlin, Germany
| | | | - Peter Albers
- grid.14778.3d0000 0000 8922 7789Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Julia Heinzelbecker
- grid.411937.9Department of Urology and Paediatric Urology, Saarland University Medical Centre and Saarland University Faculty of Medicine, Homburg, Saar Germany
| | - Sabine Kliesch
- grid.16149.3b0000 0004 0551 4246Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University Hospital, Münster, Münster, Germany
| | - Julia Lackner
- UroEvidence@Deutsche Gesellschaft Für Urologie, Berlin, Germany
| | - David Pfister
- grid.411097.a0000 0000 8852 305XDepartment of Urology, University Hospital Cologne, Cologne, Germany
| | - Christian Ruf
- Department of Urology, Bundeswehrkrankenhaus (German Federal Armed Forces Hospital), Koblenz, Germany
| | | | - Friedemann Zengerling
- grid.410712.10000 0004 0473 882XDepartment of Urology, University Hospital Ulm, Ulm, Germany
| | - Dirk Beyersdorff
- grid.13648.380000 0001 2180 3484Clinic and Polyclinic for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Winter C, Zengerling F, Busch J, Heinzelbecker J, Pfister D, Ruf C, Lackner J, Albers P, Kliesch S, Schmidt S, Bokemeyer C. How to classify, diagnose, treat and follow-up extragonadal germ cell tumors? A systematic review of available evidence. World J Urol 2022; 40:2863-78. [PMID: 35554637 DOI: 10.1007/s00345-022-04009-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 02/01/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To present the current evidence and the development of studies in recent years on the management of extragonadal germ cell tumors (EGCT). METHODS A systematic literature search was conducted in Medline and the Cochrane Library. Studies within the search period (January 2010 to February 2021) that addressed the classification, diagnosis, prognosis, treatment, and follow-up of extragonadal tumors were included. Risk of bias was assessed and relevant data were extracted in evidence tables. RESULTS The systematic search identified nine studies. Germ cell tumors (GCT) arise predominantly from within the testis, but about 5% of the tumors are primarily located extragonadal. EGCT are localized primarily mediastinal or retroperitoneal in the midline of the body. EGCT patients are classified according to the IGCCCG classification. Consecutively, all mediastinal non-seminomatous EGCT patients belong to the "poor prognosis" group. In contrast mediastinal seminoma and both retroperitoneal seminoma and non-seminoma patients seem to have a similar prognosis as patients with gonadal GCTs and metastasis at theses respective sites. The standard chemotherapy regimen for patients with a EGCT consists of 3-4 cycles (good vs intermediate prognosis) of bleomycin, etoposid, cisplatin (BEP); however, due to their very poor prognosis patients with non-seminomatous mediastinal GCT should receive a dose-intensified or high-dose chemotherapy approach upfront on an individual basis and should thus be referred to expert centers Ifosfamide may be exchanged for bleomycin in cases of additional pulmonary metastasis due to subsequently planned resections. In general patients with non-seminomatous EGCT, residual tumor resection (RTR) should be performed after chemotherapy. CONCLUSION In general, non-seminomatous EGCT have a poorer prognosis compared to testicular GCT, while seminomatous EGGCT seem to have a similar prognosis to patients with metastatic testicular seminoma. The current insights on EGCT are limited, since all data are mainly based on case series and studies with small patient numbers and non-comparative studies. In general, systemic treatment should be performed like in testicular metastatic GCTs but upfront dose intensification of chemotherapy should be considered for mediastinal non-seminoma patients. Thus, EGCT should be referred to interdisciplinary centers with utmost experience in the treatment of germ cell tumors.
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Heinzelbecker J, Schmidt S, Lackner J, Busch J, Bokemeyer C, Classen J, Dieing A, Hakenberg O, Krege S, Papachristofilou A, Pfister D, Ruf C, Schmelz H, Schmidberger H, Souchon R, Winter C, Zengerling F, Kliesch S, Albers P, Oing C. Therapy of clinical stage IIA and IIB seminoma: a systematic review. World J Urol 2022; 40:2829-41. [PMID: 34779882 DOI: 10.1007/s00345-021-03873-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The optimal treatment for clinical stage (CS) IIA/IIB seminomas is still controversial. We evaluated current treatment options. METHODS A systematic review was performed. Only randomized clinical trials and comparative studies published from January 2010 until February 2021 were included. Search items included: seminoma, CS IIA, CS IIB and therapy. Outcome parameters were relapse rate (RR), relapse-free (RFS), overall and cancer-specific survival (OS, CSS). Additionally, acute and long-term side effects including secondary malignancies (SMs) were analyzed. RESULTS Seven comparative studies (one prospective and six retrospective) were identified with a total of 5049 patients (CS IIA: 2840, CS IIB: 2209). The applied treatment modalities were radiotherapy (RT) (n = 3049; CS IIA: 1888, CSIIB: 1006, unknown: 155) and chemotherapy (CT) or no RT (n = 2000; CS IIA: 797, CS IIB: 1074, unknown: 129). In CS IIA, RRs ranged from 0% to 4.8% for RT and 0% for CT. Concerning CS IIB RRs of 9.5%-21.1% for RT and of 0%-14.2% for CT have been reported. 5-year OS ranged from 90 to 100%. Only two studies reported on treatment-related toxicities. CONCLUSIONS RT and CT are the most commonly applied treatments in CS IIA/B seminoma. In CS IIA seminomas, RRs after RT and CT are similar. However, in CS IIB, CT seems to be more effective. Survival rates of CS IIA/B seminomas are excellent. Consequently, long-term toxicities and SMs are important survivorship issues. Alternative treatment approaches, e.g., retroperitoneal lymph node dissection (RPLND) or dose-reduced sequential CT/RT are currently under prospective investigation.
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Wakileh GA, Ruf C, Heidenreich A, Dieckmann KP, Lisson C, Prasad V, Bolenz C, Zengerling F. Contemporary options and future perspectives: three examples highlighting the challenges in testicular cancer imaging. World J Urol 2021; 40:307-315. [PMID: 34779884 PMCID: PMC8921012 DOI: 10.1007/s00345-021-03856-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/04/2021] [Indexed: 10/27/2022] Open
Abstract
PURPOSE One of the main issues in testicular germ cell tumors (TGCTs) management is to reduce the necessary amount of treatment to achieve cure. Excess treatment burden may arise from late diagnosis of the primary as well as from false positive or negative staging results. Correct imaging is of paramount importance for successful management of TGCT. The aim of this review is to point out the current state of the art as well as innovative developments in TGCT imaging on the basis of three common challenging clinical situations. METHODS A selective literature search was performed in PubMed, Medline as well as in recent conference proceedings. RESULTS Regarding small testicular lesions, recent studies using elastography, contrast-enhanced ultrasound or magnetic resonance imaging (MRI) showed promising data for differentiation between benign and malignant histology. For borderline enlarged lymph nodes FDG-PET-CT performance is unsatisfactory, promising new techniques as lymphotropic nanoparticle-enhanced MRI is the subject of research in this field. Regarding the assessment of postchemotherapeutic residual masses, the use of conventional computerized tomography (CT) together with serum tumor markers is still the standard of care. To avoid overtreatment in this setting, new imaging modalities like diffusion-weighted MRI and radiomics are currently under investigation. For follow-up of clinical stage I TGCTs, the use of MRI is non-inferior to CT while omitting radiation exposure. CONCLUSION Further efforts should be made to refine imaging for TGCT patients, which is of high relevance for the guidance of treatment decisions as well as the associated treatment burdens and oncological outcomes.
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Affiliation(s)
- Gamal Anton Wakileh
- Department of Urology and Paediatric Urology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Christian Ruf
- Department of Urology, Armed Forces Hospital Ulm, Ulm, Germany
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, Cologne University Hospital, Cologne, Germany
| | | | - Catharina Lisson
- Department for Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Vikas Prasad
- Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany. .,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany.
| | - Christian Bolenz
- Department of Urology and Paediatric Urology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany. .,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany.
| | - Friedemann Zengerling
- Department of Urology and Paediatric Urology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany. .,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany.
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Kliesch S. [Diagnosis and treatment of Leydig cell tumors]. Urologe A 2021; 60:880-885. [PMID: 34223942 DOI: 10.1007/s00120-021-01576-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tumors of the testes not originating from germinal epithelium are a rare entity and represent a diagnostic and therapeutic challenge. Leydig cell tumors (LCT) are rare stromal tumors of the testis. OBJECTIVES To present current approaches in diagnostic and treatment of LCT. METHODS A literature search in PubMed was performed and the currently available guidelines concerning LCT were evaluated. Articles and book chapters were selected based on relevance to daily practice. RESULTS The low incidence of Leydig cell tumors not originating from the germinal epithelium, but from the stroma of the testis requires a standardized approach to determine relevant differential diagnosis and to optimize diagnosis and treatment depending on the current standard of knowledge and to determine whether it is benign or malignant. While more than 90% of LCT are benign and treatment is only restricted to the testis, malignant subtypes require radical surgical resection of the testicular and metastatic sites. CONCLUSION A standardized diagnostic and therapeutic approach as well as a prospective registry of rare LCT could facilitate further detailed analysis to improve the understanding of tumor biology resulting in optimized therapeutic guidelines including follow-up strategies.
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Affiliation(s)
- Sabine Kliesch
- Abteilung für Klinische und Operative Andrologie, Centrum für Reproduktionsmedizin und Andrologie (CeRA), EAA Training Center, WHO Kooperationszentrum zur Erforschung der männlichen Fertilität, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, D11, 48149, Münster, Deutschland.
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Ohlmann CH, Saar M, Pierchalla LC, Zangana M, Bonaventura A, Stöckle M, Siemer S, Heinzelbecker J. Indications, feasibility and outcome of robotic retroperitoneal lymph node dissection for metastatic testicular germ cell tumours. Sci Rep 2021; 11:10700. [PMID: 34021196 DOI: 10.1038/s41598-021-89823-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/30/2021] [Indexed: 12/26/2022] Open
Abstract
Data on robotic retroperitoneal lymph node dissection (R-RPLND) for metastatic testicular germ cell tumours (mTGCTs) are scarce and the use of R-RPLND itself is still under debate. The aim of our study was to evaluate the indications, feasibility and outcomes of R-RPLND, with special emphasis on differences between primary R-RPLND (pR-RPLND) and post-chemotherapeutic R-RPLND (pcR-RPLND) in mTGCTs. We retrospectively analysed the data of patients who underwent R-RPLND for mTGCT between November 2013 and September 2019 in two centres in Germany. Indications, operative technique, intra- and postoperative complications and oncologic outcome were analysed. Twenty-three mTGCT patients underwent R-RPLND (7 pR-RPLND, 16 pcR-RPLND). For pR-RPLND versus pcR-RPLND, median time of surgery was 243 min [interquartile range (IQR) 123-303] versus 359 min (IQR 202-440, p = 0.154) and median blood loss 100 mL (IQR 50-200) versus 275 mL (IQR 100-775, p = 0.018). Intra- and postoperative complications were more frequent in pcR-RPLND (pcR-RPLND: intra/post: 44%/44%; pR-RPLND: intra/post: 0%/29%). However, these were only statistically significant in the case of intraoperative complications (intra: p = 0.036, post: p = 0.579). Intraoperative complications (n = 7), conversions (n = 4) and transfusions (n = 4) occurred in pcR-RPLND patients only. After a median follow-up of 16.3 months (IQR 7.5-35.0) there were no recurrences or deaths. R-RPLND displays a valuable, minimally invasive treatment option in mTGCT. However, R-RPLND is challenging and pcR-RPLND especially bears a considerable risk of complications. This operation should be limited to patients with an easily accessible residual tumour mass and to surgeons experienced in robotic surgery and TGCT treatment.
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